Physiotherapy - Research Publications

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    "Sounds a Bit Crazy, But It Was Almost More Personal:" A Qualitative Study of Patient and Clinician Experiences of Physical Therapist-Prescribed Exercise For Knee Osteoarthritis Via Skype
    Hinman, RS ; Nelligan, RK ; Bennell, KL ; Delany, C (WILEY, 2017-12-01)
    OBJECTIVE: To explore the experience of patients and physical therapists with Skype for exercise management of knee osteoarthritis (OA). METHODS: This was a qualitative study. The Donabedian model for quality assessment in health care (structure, process, and outcomes) informed semistructured individual interview questions. The study involved 12 purposively sampled patients with knee OA who received physical therapist-prescribed exercise over Skype, and all therapists (n = 8) who delivered the intervention in a clinical trial were interviewed about their experiences. Interviews were audio recorded and transcribed. Two investigators undertook coding and analysis using a thematic approach. RESULTS: Six themes arose from both patients and therapists. The themes were Structure: technology (easy to use, variable quality, set-up assistance helpful) and patient convenience (time efficient, flexible, increased access); Process: empowerment to self-manage (facilitated by home environment and therapists focusing on effective treatment) and positive therapeutic relationships (personal undivided attention from therapists, supportive friendly interactions); and Outcomes: satisfaction with care (satisfying, enjoyable, patients would recommend, therapists felt Skype more useful as adjunct to usual practice) and patient benefits (reduced pain, improved function, improved confidence and self-efficacy). A seventh theme arose from therapists regarding process: adjusting routine treatment (need to modify habits, discomfort without hands-on, supported by research environment). CONCLUSION: Patients and physical therapists described mostly positive experiences using Skype as a service delivery model for physical therapist-supervised exercise management of moderate knee OA. Such a model is feasible and acceptable and has the potential to increase access to supervised exercise management for people with knee OA, either individually or in combination with traditional in-clinic visits.
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    Consumer Perceptions of and Willingness to Use Remotely Delivered Service Models For Exercise Management of Knee and Hip Osteoarthritis: A Cross-Sectional Survey
    Lawford, BJ ; Bennell, KL ; Hinman, RS (WILEY, 2017-05-01)
    OBJECTIVE: To investigate the perceptions of people with hip and/or knee osteoarthritis (OA) about the remote delivery of exercise therapy by a physical therapist. METHODS: A survey of people age ≥45 years with a clinical diagnosis of hip and/or knee OA was conducted. The survey comprised 3 sections, including 1) demographic information, 2) statements about receiving exercise via the telephone, and 3) statements about receiving exercise via video over the internet. Data were analyzed by calculating response proportions and evaluating levels of agreement with each statement. Exploratory binomial regression analyses were performed to determine whether participant characteristics influenced perceptions of tele-rehabilitation. RESULTS: A total of 330 people spanning metropolitan, regional, and rural Australia completed the survey. Respondents were in majority (≥50%) agreement with 13 of 17 statements, with most agreement about tele-rehabilitation saving time (telephone versus video: 78% versus 81%), being easy to use (79% versus 78%), and maintaining privacy (86% versus 82%). There was no consensus agreement with liking the lack of physical contact (telephone versus video: 20% agreement versus 22%), willingness to pay (32% versus 46%), belief that telephone-delivered exercise would be effective (45%), and belief that a physical therapist could adequately monitor OA over the telephone (42%). CONCLUSION: People with knee and/or hip OA hold mostly positive perceptions about tele-rehabilitation, delivered via the telephone or by video over the internet, for provision of physical therapist-prescribed exercise services. There was concern about the lack of physical contact with the therapist when using tele-rehabilitation.
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    Telephone Coaching to Enhance a Home-Based Physical Activity Program for Knee Osteoarthritis: A Randomized Clinical Trial
    Bennell, KL ; Campbell, PK ; Egerton, T ; Metcalf, B ; Kasza, J ; Forbes, A ; Bills, C ; Gale, J ; Harris, A ; Kolt, GS ; Bunker, SJ ; Hunter, DJ ; Brand, CA ; Hinman, RS (WILEY, 2017-01-01)
    OBJECTIVE: To investigate whether simultaneous telephone coaching improves the clinical effectiveness of a physiotherapist-prescribed home-based physical activity program for knee osteoarthritis (OA). METHODS: A total of 168 inactive adults ages ≥50 years with knee pain on a numeric rating scale ≥4 (NRS; range 0-10) and knee OA were recruited from the community and randomly assigned to a physiotherapy (PT) and coaching group (n = 84) or PT-only (n = 84) group. All participants received five 30-minute consultations with a physiotherapist over 6 months for education, home exercise, and physical activity advice. PT+coaching participants also received 6-12 telephone coaching sessions by clinicians trained in behavioral-change support for exercise and physical activity. Primary outcomes were pain (NRS) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC; score range 0-68]) at 6 months. Secondary outcomes were these same measures at 12 and 18 months, as well as physical activity, exercise adherence, other pain and function measures, and quality of life. Analyses were intent-to-treat with multiple imputation for missing data. RESULTS: A total of 142 (85%), 136 (81%), and 128 (76%) participants completed 6-, 12-, and 18-month measurements, respectively. The change in NRS pain (mean difference 0.4 unit [95% confidence interval (95% CI) -0.4, 1.3]) and in WOMAC function (1.8 [95% CI -1.9, 5.5]) did not differ between groups at 6 months, with both groups showing clinically relevant improvements. Some secondary outcomes related to physical activity and exercise behavior favored PT+coaching at 6 months but generally not at 12 or 18 months. There were no between-group differences in most other outcomes. CONCLUSION: The addition of simultaneous telephone coaching did not augment the pain and function benefits of a physiotherapist-prescribed home-based physical activity program.
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    Coordination of deep hip muscle activity is altered in symptomatic femoroacetabular impingement
    Diamond, LE ; Van den Hoorn, W ; Bennell, KL ; Wrigley, TV ; Hinman, RS ; O'Donnell, J ; Hodges, PW (WILEY, 2017-07-01)
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    Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA): a systematic review update and individual participant data meta-analysis protocol
    Holden, MA ; Burke, DL ; Runhaar, J ; van der Windt, D ; Riley, RD ; Dziedzic, K ; Legha, A ; Evans, AL ; Abbott, JH ; Baker, K ; Brown, J ; Bennell, KL ; Bossen, D ; Brosseau, L ; Chaipinyo, K ; Christensen, R ; Cochrane, T ; de Rooij, M ; Doherty, M ; French, HP ; Hickson, S ; Hinman, RS ; Hopman-Rock, M ; Hurley, MV ; Ingram, C ; Knoop, J ; Krauss, I ; McCarthy, C ; Messier, SP ; Patrick, DL ; Sahin, N ; Talbot, LA ; Taylor, R ; Teirlinck, CH ; van Middelkoop, M ; Walker, C ; Foster, NE (BMJ PUBLISHING GROUP, 2017-12-01)
    INTRODUCTION: Knee and hip osteoarthritis (OA) is a leading cause of disability worldwide. Therapeutic exercise is a recommended core treatment for people with knee and hip OA, however, the observed effect sizes for reducing pain and improving physical function are small to moderate. This may be due to insufficient targeting of exercise to subgroups of people who are most likely to respond and/or suboptimal content of exercise programmes. This study aims to identify: (1) subgroups of people with knee and hip OA that do/do not respond to therapeutic exercise and to different types of exercise and (2) mediators of the effect of therapeutic exercise for reducing pain and improving physical function. This will enable optimal targeting and refining the content of future exercise interventions. METHODS AND ANALYSIS: Systematic review and individual participant data meta-analyses. A previous comprehensive systematic review will be updated to identify randomised controlled trials that compare the effects of therapeutic exercise for people with knee and hip OA on pain and physical function to a non-exercise control. Lead authors of eligible trials will be invited to share individual participant data. Trial-level and participant-level characteristics (for baseline variables and outcomes) of included studies will be summarised. Meta-analyses will use a two-stage approach, where effect estimates are obtained for each trial and then synthesised using a random effects model (to account for heterogeneity). All analyses will be on an intention-to-treat principle and all summary meta-analysis estimates will be reported as standardised mean differences with 95% CI. ETHICS AND DISSEMINATION: Research ethical or governance approval is exempt as no new data are being collected and no identifiable participant information will be shared. Findings will be disseminated via national and international conferences, publication in peer-reviewed journals and summaries posted on websites accessed by the public and clinicians. PROSPERO REGISTRATION NUMBER: CRD42017054049.
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    Efficacy of adding a physiotherapy rehabilitation programme to arthroscopic management of femoroacetabular impingement syndrome: a randomised controlled trial (FAIR)
    Bennell, KL ; Spiers, L ; Takla, A ; O'Donnell, J ; Kasza, J ; Hunter, DJ ; Hinman, RS (BMJ PUBLISHING GROUP, 2017-06-01)
    OBJECTIVES: Although several rehabilitation programmes following hip arthroscopy for femoracetabular impingement (FAI) syndrome have been described, there are no clinical trials evaluating whether formal physiotherapy-prescribed rehabilitation improves recovery compared with self-directed rehabilitation. The objective of this study was to evaluate the efficacy of adding a physiotherapist-prescribed rehabilitation programme to arthroscopic surgery for FAI syndrome. DESIGN: Randomised controlled trial. METHODS: People aged ≥16 years with FAI syndrome scheduled for hip arthroscopy were recruited and randomly allocated to physiotherapy (PT) or control. The PT group received seven PT sessions (one preoperative and six postoperative) incorporating education, manual therapy and a progressive rehabilitation programme of home, aquatic and gym exercises while the control group did not undertake PT rehabilitation. Measurements were taken at baseline (2 weeks presurgery) and 14 and 24 weeks postsurgery. The primary outcomes were the International Hip Outcome Tool (iHOT-33) and the sport subscale of the Hip Outcome Score (HOS) at week 14. RESULTS: Due to slower than expected recruitment and funding constraints, recruitment was ceased after 23 months. Thirty participants (14 PT and 16 control) were randomised and 28 (14 PT and 14 control; 93%) and 22 (11 PT and 11 control; 73%) completed week 14 and 24 measurements, respectively. For the 14-week primary outcomes, the PT group showed significantly greater improvements on the iHOT-33 (mean difference 14.2 units; 95% CI 1.2 to 27.2) and sport subscale of the HOS (13.8 units; 95% CI 0.3 to 27.3). There were no significant between-group differences at week 24. CONCLUSIONS: An individual PT treatment and rehabilitation programme may augment improvements in patient-reported outcomes following arthroscopy for FAI syndrome. However, given the small sample size, larger trials are needed to validate the findings. TRIAL REGISTRATION NUMBER: Trial registered with the Australian New Zealand Clinical Trials Registry :ACTRN12613000282785, Results.
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    Addition of transcranial direct current stimulation to quadriceps strengthening exercise in knee osteoarthritis: A pilot randomised controlled trial
    Chang, W-J ; Bennell, KL ; Hodges, PW ; Hinman, RS ; Young, CL ; Buscemi, V ; Liston, MB ; Schabrun, SM ; Avenanti, A (PUBLIC LIBRARY SCIENCE, 2017-06-30)
    A randomised, assessor- and participant-blind, sham-controlled trial was conducted to assess the safety and feasibility of adding transcranial direct current stimulation (tDCS) to quadriceps strengthening exercise in knee osteoarthritis (OA), and provide data to inform a fully powered trial. Participants were randomised to receive active tDCS+exercise (AT+EX) or sham tDCS+exercise (ST+EX) twice weekly for 8 weeks whilst completing home exercises twice per week. Feasibility, safety, patient-perceived response, pain, function, pressure pain thresholds (PPTs) and conditioned pain modulation (CPM) were assessed before and after treatment. Fifty-seven people were screened for eligibility. Thirty (52%) entered randomisation and 25 (84%) completed the trial. One episode of headache in the AT+EX group was reported. Pain reduced in both groups following treatment (AT+EX: p<0.001, partial η2 = 0.55; ST+EX: p = 0.026, partial η2 = 0.18) but no between-group differences were observed (p = 0.18, partial η2 = 0.08). Function improved in the AT+EX (p = 0.01, partial η2 = 0.22), but not the ST+EX (p = 0.16, partial η2 = 0.08) group, between-group differences did not reach significance (p = 0.28, partial η2 = 0.052). AT+EX produced greater improvements in PPTs than ST+EX (p<0.05) (superolateral knee: partial η2 = 0.17; superior knee: partial η2 = 0.3; superomedial knee: partial η2 = 0.26). CPM only improved in the AT+EX group but no between-group difference was observed (p = 0.054, partial η2 = 0.158). This study provides the first feasibility and safety data for the addition of tDCS to quadriceps strengthening exercise in knee OA. Our data suggest AT+EX may improve pain, function and pain mechanisms beyond that of ST+EX, and provides support for progression to a fully powered randomised controlled trial.
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    Impairments, activity limitations and participation restrictions experienced in the first year following a critical illness: protocol for a systematic review
    Ohtake, PJ ; Scott, JC ; Hinman, RS ; Lee, AC ; Smith, JM (BMJ PUBLISHING GROUP, 2017-01-01)
    INTRODUCTION: Critical illness requiring intensive care unit (ICU) management is a life-altering event with ∼25% of ICU survivors experiencing persistent reductions in physical functioning, impairments in mental health, cognitive dysfunction and decreased quality of life. This constellation of problems is known as 'postintensive care syndrome' (PICS) and may persist for months and/or years. The purpose of this systematic review is to identify the scope and magnitude of physical problems associated with PICS during the first year after discharge from ICU, using the International Classification of Functioning, Disability and Health framework to elucidate the impairments of body functions and structures, activity limitations and participation restrictions. METHODS AND ANALYSIS: Medline (Ovid), Cochrane Database of Systematic Reviews (Ovid), Cochrane Central Register of Controlled Trials (Ovid), PubMed, CINAHL (EBSCO), Web of Science and EMBASE will be systematically searched for observational studies reporting the physical impairments of body functions and structures, activity limitations and participation restrictions associated with PICS. Two reviewers will assess the articles for eligibility according to prespecified selection criteria, after which an independent reviewer will perform data extraction which will be validated by a second independent reviewer. Quality appraisal will be performed by two independent reviewers. Outcomes of the included studies will be summarised in tables and in narrative format and meta-analyses will be conducted where appropriate. ETHICS AND DISSEMINATION: Formal ethical approval is not required as no primary data is collected. This systematic review will identify the scope and magnitude of physical problems associated with PICS during the first year after discharge from ICU and will be disseminated through a peer-reviewed publication and at conference meetings, to inform practice and future research on the physical problems associated with PICS. TRIAL REGISTRATION NUMBER: CRD42015023520.
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    Lateral wedges with and without custom arch support for people with medial knee osteoarthritis and pronated feet: an exploratory randomized crossover study
    Hunt, MA ; Takacs, J ; Krowchuk, NM ; Hatfield, GL ; Hinman, RS ; Chang, R (BMC, 2017-05-02)
    BACKGROUND: Pronated foot posture is associated with many clinical and biomechanical outcomes unique to medial compartment knee osteoarthritis (OA). Though shoe-worn insole treatment, including lateral wedges, is commonly studied in this patient population, their effects on the specific subgroup of people with medial knee OA and concomitant pronated feet are unknown. The purpose of this study was to evaluate whether lateral wedge insoles with custom arch support are more beneficial than lateral wedge insoles alone for knee and foot symptoms in people with medial tibiofemoral knee osteoarthritis (OA) and pronated feet. METHODS: Twenty-six people with pronated feet and symptomatic medial knee OA participated in a randomized crossover study comparing five degree lateral wedge foot insoles with and without custom foot arch support. Each intervention was worn for two months, separated by a two-month washout period of no insoles wear. Main outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function subscales, the revised short-form Foot Function Index (FFI-R) pain and stiffness subscales, and the timed stair climb test. Regression modeling was conducted to examine treatment, period, and interaction effects. RESULTS: Twenty-two participants completed the study, and no carryover or interaction effects were observed for any outcome. Significant treatment effects were observed for the timed stair climb, with greater improvements seen with the lateral wedges with arch support. Within-condition significant improvements were observed for WOMAC pain and physical function, as well as FFI-R pain and stiffness with lateral wedges with arch support use. More adverse effects were reported with the lateral wedges alone, while more people preferred the lateral wedges with arch support overall. CONCLUSIONS: Addition of custom arch support to a standard lateral wedge insole may improve foot and knee symptoms in people with knee OA and concomitant pronated feet. These preliminary findings suggest further research evaluating the role of shoe-worn insoles for treatment of this specific sub-group of people with knee OA is warranted. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02234895.
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    Plug-in-Gait calculation of the knee adduction moment in people with knee osteoarthritis during shod walking: comparison of two different foot marker models
    Paterson, KL ; Hinman, RS ; Metcalf, BR ; Bennell, KL ; Wrigley, TV (BMC, 2017-02-04)
    BACKGROUND: Understanding how kinematic multi-segment foot modelling influences the utility of Plug-in-Gait calculations of the knee adduction moment (KAM) during shod walking is relevant to knee osteoarthritis (OA). Multi-segment foot markers placed on the skin through windows cut in to the shoe provide a more accurate representation of foot mechanics than the traditional marker set used by Plug-in-Gait, which uses fewer markers, placed on the shoe itself. We aimed to investigate whether Plug-in-Gait calculation of the KAM differed when using a kinematic multi-segment foot model compared to the traditional Plug-in-Gait marker set. METHODS: Twenty people with medial knee OA underwent gait analysis in two test conditions: i) Plug-in-Gait model with its two standard foot markers placed on the shoes and; ii) Plug-in-Gait with the heel marker virtualised from a modified-Oxford Foot Model where 8 ft markers were placed on the skin through windows cut in shoe uppers. Outcomes were the peak KAM, KAM impulse and other knee kinetic and kinematic variables. RESULTS: There were no differences (P > 0.05) in any gait variables between conditions. Excellent agreement was found for all outcome variables, with high correlations (r > 0.88-0.99, P < 0.001), narrow limits of agreement and no proportional bias (R2 = 0.03-0.14, P > 0.05). The mean difference and 95% confidence intervals for peak KAM were also within the minimal detectable change range demonstrating equivalence. CONCLUSIONS: Plug-in-Gait calculations of the KAM are not altered when using a kinematic multi-segment foot marker model with skin markers placed through windows cut in to the shoe, instead of the traditional marker set placed on top of shoes. Researchers may be confident that applying either foot model does not change the calculation of the KAM using Plug-in-Gait.